What is Otitis Media

 

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What is Otitis Media

What is Otitis Media?

Otitis media (OM) refers to all forms of inflammation and infection of the middle ear, sometimes known as “glue ear” or “runny ears”, causing hearing loss and communications problems.

What causes OM?

Active inflammation or infection is nearly always associated with fluid in the middle ear space (a middle ear effusion).  Bacteria that initially colonise the nose and nasopharynx ascend to the middle ear via the Eustachian tube. The host inflammatory response causes fluid to build up in the middle ear space, resulting in bulging of the eardrum which can be extremely painful. The eardrum may even burst. OM may also be present without noticeable symptoms and can persist for long periods undetected.

So what?

One of the most critical consequences of OM is its impact on hearing.

Damage or disorders of the outer or middle parts of the ear affects the way that sound is carried, or conducted, through to the inner ear and the rest of the auditory system. Otitis media, which mainly affects children, is the most common cause of conductive hearing loss. Hearing loss associated with persistent middle ear infection during the early years of childhood impacts upon a child’s learning, language development and communication, and psychosocial development. The child may experience speech delay, auditory processing disorder (APD), social isolation, and educational disadvantage. For families, OM may result in distress, time off from work for parents, visits to the doctor or clinic, and ongoing medical costs.

Otitis media affects a higher proportion of children who have contact with other children, such as in day care centres. Highest rates occur in communities where there is greater general disadvantage, such as in remote Indigenous communities in the Northern Territory (NT). Conditions of overcrowded housing, poor nutrition, compromised hygiene, smoke exposure and limited access to routine medical care can all be contributing factors to the prevalence of OM.

Otitis Media in Aboriginal and Torres Strait Islander (Indigenous) Children

Across Australia, including in urban areas of capital cities, OM is far more frequent and serious among Indigenous than non-Indigenous children. In fact, Indigenous Australian children have the highest reported rate of otitis media and burst ear drums in the world. While acute middle ear infections cause ear pain among non-Indigenous children, scientists have struggled to identify why the condition is generally not painful for many Indigenous children. Without the presence of ear pain, parents are unaware of their child's infection and it progresses undetected, often resulting in perforated ear drums and chronic suppuratives otitis media (CSOM), known as runny ears. In the Northern Territory remote communities in 2013, 86% of Indigenous children below 3 years of age had some form of OM, 14% of these had a perforated ear drum. This contrasts with a national prevalence of just 0.1% among non-Indigenous children. In remote areas, OM begins within weeks of birth and persists for months or even years. In many of these remote communities, “runny ears” have become normalised.

Decline in prevalence of runny ears

Fortunately, our ongoing surveillance of OM in remote areas has found a consistent decline in the prevalence of CSOM among Indigenous children, from 24% in 2001 to 14% in 2012. While this constitutes a significant reduction, these prevalence rates are still extremely high. The World Health Organisation (WHO) considers that a 4% prevalence rate of CSOM constitutes a “public health emergency” requiring immediate attention. The prevalence rate amongst Australia’s Indigenous children therefore is startlingly higher than the WHO’s emergency levels.

For Indigenous children, the severity and duration of hearing loss experienced in early life is having a devastating impact on social development and educational achievement. Hearing loss impacts upon a child’s ability to connect with family members, play with friends, and develop academically. Young people with hearing loss may feel isolated from their peers and may find education frustrating and difficult. This may cause them to disengage from school, leave early and ultimately get in trouble with the law.

Several recent studies in the Northern Territory have found that around 90% of Indigenous prison inmates have significant hearing loss. Hearing impairment further affects comprehension of complex interactions with services and authorities, including hospitals, police and the criminal justice system. For many Indigenous people, English is a second language which poses a further challenge to communication with significant hearing loss.

For researchers

Otitis Media (OM), sometimes known as glue ear or runny ears…

For health practitioners

Otitis Media (OM), sometimes known as glue ear or runny ears…

For families and communities

Many Indigenous children, and almost all Indigenous children living in remote communities...